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Arthritis Research & Therapy
Published in: Arthritis Research & Therapy 4/2010

Open Access 01-08-2010 | Research article

Risk factors for total joint arthroplasty infection in patients receiving tumor necrosis factor α-blockers: a case-control study

Authors: Mélanie Gilson, Laure Gossec, Xavier Mariette, Dalenda Gherissi, Marie-Hélène Guyot, Jean-Marie Berthelot, Daniel Wendling, Christian Michelet, Pierre Dellamonica, Florence Tubach, Maxime Dougados, Dominique Salmon

Published in: Arthritis Research & Therapy | Issue 4/2010

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Abstract

Introduction

The objective of this study was to assess natural microbial agents, history and risk factors for total joint arthroplasty (TJA) infections in patients receiving tumor necrosis factor (TNF)α-blockers, through the French RATIO registry and a case-control study.

Methods

Cases were TJA infections during TNFα-blocker treatments. Each case was compared to two controls (with TJA and TNFα-blocker therapy, but without TJA infection) matched on age (±15 years), TJA localization, type of rheumatic disorder and disease duration (±15 years). Statistical analyses included univariate and multivariate analyses with conditional logistic regression.

Results

In the 20 cases (18 rheumatoid arthritis), TJA infection concerned principally the knee (n = 12, 60%) and the hip (n = 5, 25%). Staphylococcus was the more frequent microorganism involved (n = 15, 75%). Four patients (20%) were hospitalized in an intensive care unit and two died from infection. Eight cases (40%) versus 5 controls (13%) had undergone primary TJA or TJA revision for the joint subsequently infected during the last year (P = 0.03). Of these procedures, 5 cases versus 1 control were performed without withdrawing TNFα-blockers (P = 0.08). In multivariate analysis, predictors of infection were primary TJA or TJA revision for the joint subsequently infected within the last year (odds ratio, OR = 88.3; 95%CI 1.1-7,071.6; P = 0.04) and increased daily steroid intake (OR = 5.0 per 5 mg/d increase; 1.1-21.6; P = 0.03). Case-control comparisons showed similar distribution between TNFα-blockers (P = 0.70).

Conclusions

In patients receiving TNFα-blockers, TJA infection is rare but potentially severe. Important risk factors are primary TJA or TJA revision within the last year, particularly when TNFα-blockers are not interrupted before surgery, and the daily steroid intake.
Literature
1.
Maini RN, Breedveld FC, Kalden JR, Smolen JS, David D, Macfarlane JD, Antoni C, Leeb B, Elliott MJ, Woody JN, Schaible TF, Feldmann M: Therapeutic efficacy of multiple intravenous infusions of anti-tumor necrosis factor alpha monoclonal antibody combined with low-dose weekly methotrexate in rheumatoid arthritis. Arthritis Rheum. 1998, 41: 1552-1563. 10.1002/1529-0131(199809)41:9<1552::AID-ART5>3.0.CO;2-W.CrossRefPubMed
2.
Gorman JD, Sack KE, Davis JC: Treatment of ankylosing spondylitis by inhibition of tumor necrosis factor alpha. N Engl J Med. 2002, 346: 1349-1356. 10.1056/NEJMoa012664.CrossRefPubMed
3.
4.
Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Allaart CF, van Zeben D, Kerstens PJ, Hazes JM, Zwinderman AH, Ronday HK, Han KH, Westedt ML, Gerards AH, van Groenendael JH, Lems WF, van Krugten MV, Breedveld FC, Dijkmans BA: Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): A randomized, controlled trial. Arthritis Rheum. 2008, 58: S126-135. 10.1002/art.23364.CrossRefPubMed
5.
Keystone EC, Kavanaugh AF, Sharp JT, Tannenbaum H, Hua Y, Teoh LS, Fischkoff SA, Chartash EK: Radiographic, clinical, and functional outcomes of treatment with adalimumab (a human anti-tumor necrosis factor monoclonal antibody) in patients with active rheumatoid arthritis receiving concomitant methotrexate therapy: a randomized, placebo-controlled, 52-week trial. Arthritis Rheum. 2004, 50: 1400-1411. 10.1002/art.20217.CrossRefPubMed
6.
Van der Heijde D, Klareskog L, Landewé R, Bruyn GA, Cantagrel A, Durez P, Herrero-Beaumont G, Molad Y, Codreanu C, Valentini G, Zahora R, Pedersen R, MacPeek D, Wajdula J, Fatenejad S: Disease remission and sustained halting of radiographic progression with combination etanercept and methotrexate in patients with rheumatoid arthritis. Arthritis Rheum. 2007, 56: 3928-3939. 10.1002/art.23141.CrossRefPubMed
7.
Verstappen SM, Hoes JN, Ter Borg EJ, Bijlsma JW, Blaauw AA, van Albada-Kuipers GA, van Booma-Frankfort C, Jacobs JW: Joint surgery in the Utrecht rheumatoid arthritis cohort: the effect of treatment strategy. Ann Rheum Dis. 2006, 65: 1506-1511. 10.1136/ard.2005.049957.PubMedCentralCrossRefPubMed
8.
Da Silva E, Doran MF, Crowson CS, O'Fallon WM, Matteson EL: Declining use of orthopedic surgery in patients with rheumatoid arthritis? Results of a long-term, population-based assessment. Arthritis Rheum. 2003, 49: 216-220. 10.1002/art.10998.CrossRefPubMed
9.
Keane J, Gershon S, Wise RP, Mirabile-Levens E, Kasznica J, Schwieterman WD, Siegel JN, Braun MM: Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. N Engl J Med. 2001, 345: 1098-1104. 10.1056/NEJMoa011110.CrossRefPubMed
10.
Tubach F, Salmon D, Ravaud P, Allanore Y, Goupille P, Bréban M, Pallot-Prades B, Pouplin S, Sacchi A, Chichemanian RM, Bretagne S, Emilie D, Lemann M, Lortholary O, Mariette X, Research Axed on Tolerance of Biotherapies Group: Risk of tuberculosis is higher with anti-tumor necrosis factor monoclonal antibody therapy than with soluble tumor necrosis factor receptor therapy: The three-year prospective French Research Axed on Tolerance of Biotherapies registry. Arthritis Rheum. 2009, 60: 1884-1894. 10.1002/art.24632.PubMedCentralCrossRefPubMed
11.
Bongartz T, Sutton AJ, Sweeting MJ, Buchan I, Matteson EL, Montori V: Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials. JAMA. 2006, 295: 2275-2285. 10.1001/jama.295.19.2275.CrossRefPubMed
12.
Leombruno JP, Einarson TR, Keystone EC: The safety of anti-Tumor Necrosis Factor treatments in rheumatoid arthritis: meta and exposure-adjusted pooled analyses of serious adverse events. Ann Rheum Dis. 2009, 68: 1136-1145. 10.1136/ard.2008.091025.CrossRefPubMed
13.
Salliot C, Gossec L, Ruyssen-Witrand A, Luc M, Duclos M, Guignard S, Dougados M: Infections during tumour necrosis factor-α blocker therapy for rheumatic diseases in daily practice: a systematic retrospective study of 709 patients. Rheumatology. 2007, 46: 327-334. 10.1093/rheumatology/kel236.CrossRefPubMed
14.
Curtis JR, Patkar N, Xie A, Martin C, Allison JJ, Saag M, Shatin D, Saag KG: Risk of serious bacterial infections among rheumatoid arthritis patients exposed to tumor necrosis factor α antagonists. Arthritis Rheum. 2007, 56: 1125-1133. 10.1002/art.22504.CrossRefPubMed
15.
Dixon WG, Watson K, Lunt M, Hyrich KL, Silman AJ, Symmons DP: British Society for Rheumatology Biologics Registry. Rates of serious infection, including site-specific and bacterial intracellular infection, in rheumatoid arthritis patients receiving anti-tumor necrosis factor therapy: results from the British Society for Rheumatology Biologics Registry. Arthritis Rheum. 2006, 54: 2368-2376. 10.1002/art.21978.CrossRefPubMed
16.
Schneeweiss S, Setoguchi S, Weinblatt ME, Katz JN, Avorn J, Sax PE, Levin R, Solomon DH: Anti-tumor necrosis factor alpha therapy and the risk of serious bacterial infections in elderly patients with rheumatoid arthritis. Arthritis Rheum. 2007, 56: 1754-1764. 10.1002/art.22600.CrossRefPubMed
17.
NIH consensus development panel on total hip replacement: NIH consensus conference: total hip replacement. JAMA. 1995, 273: 1950-1956. 10.1001/jama.273.24.1950.CrossRef
18.
Sperling JW, Kosak TK, Hanssen AD, Cofield RH: Infection after shoulder arthroplasty. Clin Orthop. 2001, 382: 206-216. 10.1097/00003086-200101000-00028.CrossRefPubMed
19.
Harris WH, Sledge CB: Total hip and total knee replacement. N Engl J Med. 1990, 323: 801-807. 10.1056/NEJM199009203231206.CrossRefPubMed
20.
Debarge R, Nicolle MC, Pinaroli A, Ait Si Selmi T, Neyret P: Surgical site infection after total knee arthroplasty: a monocenter analysis of 923 first-intention implantations. Rev Chir Orthop Reparatrice Appar Mot. 2007, 93: 582-587.CrossRefPubMed
21.
Bongartz T, Halligan CS, Osmon DR, Reinalda MS, Bamlet WR, Crowson CS, Hanssen AD, Matteson EL: Incidence and risk factors of prosthetic joint infection after total hip or knee replacement in patients with rheumatoid arthritis. Arthritis Rheum. 2008, 59: 1713-1720. 10.1002/art.24060.PubMedCentralCrossRefPubMed
22.
Chesney D, Sales J, Elton R, Brenkel IJ: Infection after knee arthroplasty a prospective study of 1509 cases. J Arthroplasty. 2008, 23: 355-359. 10.1016/j.arth.2007.05.052.CrossRefPubMed
23.
Bongartz T: Elective orthopedic surgery and perioperative DMARD management: many questions, fewer answers, and some opinions. J Rheumatol. 2007, 34: 653-655.PubMed
24.
Talwalkar SC, Grennan DM, Gray J, Johnson P, Hayton MJ: Tumour necrosis factor alpha antagonists and early postoperative complications in patients with inflammatory joint disease undergoing elective orthopaedic surgery. Ann Rheum Dis. 2005, 64: 650-651. 10.1136/ard.2004.028365.PubMedCentralCrossRefPubMed
25.
Bibbo C, Goldberg JW: Infectious and healing complications after elective orthopaedic foot and ankle surgery during tumor necrosis factor-alpha inhibition therapy. Foot Ankle Int. 2004, 25: 331-335.PubMed
26.
Shergy WJ, Isern RA, Cooley DA, Harshbarger JL, Huffstutter JE, Hughes GM, Spencer-Smith EA, Goldman AL, Roth SH, Toder JS, Warner D, Quinn A, Keenan GF, Schaible TF, PROMPT Study Group.Profiling Remicade Onset with MTX in a Prospective Trial: Open label study to assess infliximab safety and timing of onset of clinical benefit among patients with rheumatoid arthritis. J Rheumatol. 2002, 29: 667-677.PubMed
27.
Giles JT, Bartlett SJ, Gelber AC, Nanda S, Fontaine K, Ruffing V, Bathon JM: Tumor necrosis factor inhibitor therapy and risk of serious postoperative orthopedic infection in rheumatoid arthritis. Arthritis Rheum. 2006, 55: 333-337. 10.1002/art.21841.CrossRefPubMed
28.
Ruyssen-Witrand A, Gossec L, Salliot C, Luc M, Duclos M, Guignard S, Dougados M: Complication rates of 127 surgical procedures performed in rheumatic patients receiving tumor necrosis factor alpha blockers. Clin Exp Rheumatol. 2007, 25: 430-436.PubMed
29.
Berbari EF, Hanssen AD, Duffy MC, Steckelberg JM, Ilstrup DM, Harmsen WS, Osmon DR: Risk factors for prosthetic joint infection: case-control study. Clin Infect Dis. 1998, 27: 1247-1254. 10.1086/514991.CrossRefPubMed
30.
31.
Tubach F, Salmon-Céron D, Ravaud P, Mariette X pour le groupe RATIO: The RATIO observatory: a French registry of opportunistic infections, severe bacterial infections and complicating anti TNF therapy. Joint Bone Spine. 2005, 72: 456-460. 10.1016/j.jbspin.2005.10.004.CrossRefPubMed
32.
33.
34.
Van Gestel AM, Anderson JJ, van Riel PL, Boers M, Haagsma CJ, Rich B, Wells G, Lange ML, Felson DT: ACR and EULAR improvement criteria have comparable validity in rheumatoid arthritis trials. American College of Rheumatology European League of Associations for Rheumatology. J Rheumatol. 1999, 26: 705-711.PubMed
35.
Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM: CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988, 16: 128-140. 10.1016/0196-6553(88)90053-3.CrossRefPubMed
36.
Tsukayama DT, Estrada R, Gustilo RB: Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J Bone Joint Surg Am. 1996, 78: 512-523.PubMed
37.
Segawa H, Tsukayama DT, Kyle R, Becker D, Gustilo R: Infection after total knee arthroplasty. J Bone Joint Surg Am. 1999, 81: 1434-1445.PubMed
38.
Berbari EF, Osmon DR, Duffy MC, Harmssen RN, Mandrekar JN, Hanssen AD, Steckelberg JM: Outcome of prosthetic joint infection in patients with rheumatoid arthritis: the impact of medical and surgical therapy in 200 episodes. Clin Infect Dis. 2006, 42: 216-223. 10.1086/498507.CrossRefPubMed
39.
40.
Doran MF, Crowson CS, Pond GR, O'Fallon WM, Gabriel SE: Predictors of infection in rheumatoid arthritis. Arthritis Rheum. 2002, 46: 2294-2300. 10.1002/art.10529.CrossRefPubMed
41.
Bernatsky S, Hudson M, Suissa S: Anti-rheumatic drug use and risk of serious infections in rheumatoid arthritis?. Rheumatology. 2007, 46: 1157-1160. 10.1093/rheumatology/kem076.CrossRefPubMed
42.
Naveau S, Chollet-Martin S, Dharancy S, Mathurin P, Jouet P, Piquet MA, Davion T, Oberti F, Broët P, Emilie D, Foie-Alcool group of the Association Française pour l'Etude du Foie: A double-blind randomized controlled trial of infliximab associated with prednisolone in acute alcoholic hepatitis. Hepatology. 2004, 39: 1390-1397. 10.1002/hep.20206.CrossRefPubMed
43.
Den Broeder AA, Creemers MC, Fransen J, de Jong E, de Rooij DJ, Wymenga A, de Waal-Malefijt M, van den Hoogen FH: Risk factors for surgical site infections and other complications in elective surgery in patients with rheumatoid arthritis with special attention for anti-tumor necrosis factor: a large retrospective study. J Rheumatol. 2007, 34: 689-695.PubMed
44.
Fautrel B, Constantin A, Morel J, Vittecoq O, Cantagrel A, Combe B, Dougados M, Le Loët X, Mariette X, Pham T, Puéchal X, Sibilia J, Soubrier M, Ravaud P, Rheumatism and Inflammation Club (CRI) and of the French Society for Rheumatology: Recommendations of the French Society for Rheumatology. TNFalpha antagonist therapy in rheumatoid arthritis. Joint Bone Spine. 2006, 73: 433-441. 10.1016/j.jbspin.2006.04.001.CrossRefPubMed
45.
Nederlandse Vereniging voor Rheumatologie: Medicijnen: het toepassen van TNF blokkade in de behandeling reumatoïde artritis. 2003, Utrecht: Dutch Society for Rheumatology
46.
Went P, Krismer M, Frischhut B: Recurrence of infection after revision of infected hip arthroplasty. J Bone Joint Surg Br. 1995, 77: 307-309.PubMed
47.
Ledingham J, Deighton C, on behalf the British Society for Rheumatology Standards, Guidelines and Audit Working Group: Update on the British Society for Rheumatology Guidelines for prescribing TNFα blockers in adults with rheumatoid arthritis (update of previous guidelines of April 2001). Rheumatology. 2005, 44: 157-163. 10.1093/rheumatology/keh464.CrossRefPubMed
48.
Grennan DM, Gray J, Loudon J, Fear S: Methotrexate and early postoperative complications in patients with rheumatoid arthritis undergoing elective orthopaedic surgery. Ann Rheum Dis. 2001, 60: 214-217. 10.1136/ard.60.3.214.PubMedCentralCrossRefPubMed
49.
Carpenter MT, West SG, Vogelgesang SA, Casey Jones DE: Postoperative joint infections in rheumatoid arthritis patients on methotrexate therapy. Orthopedics. 1996, 19: 207-210.PubMed
50.
Bridges SL, Lopez-Mendez A, Han KH, Tracy IC, Alarcon GS: Should methotrexate be discontinued before elective orthopedic surgery in patients with rheumatoid arthritis?. J Rheumatol. 1991, 18: 984-988.PubMed
51.
Stefánsdóttir A, Johansson D, Knutson K, Lidgren L, Robertsson O: Microbiology of the infected knee arthroplasty: report from the Swedish Knee Arthroplasty Register on 426 surgically revised cases. Scand J Infect Dis. 2009, 41: 831-840. 10.3109/00365540903186207.CrossRefPubMed
52.
Dale H, Hallan G, Espehaug B, Havelin LI, Engesaeter LB: Increasing risk of revision due to deep infection after hip arthroplasty. Acta Orthop. 2009, 80: 639-645. 10.3109/17453670903506658.PubMedCentralCrossRefPubMed
Metadata
Title
Risk factors for total joint arthroplasty infection in patients receiving tumor necrosis factor α-blockers: a case-control study
Authors
Mélanie Gilson
Laure Gossec
Xavier Mariette
Dalenda Gherissi
Marie-Hélène Guyot
Jean-Marie Berthelot
Daniel Wendling
Christian Michelet
Pierre Dellamonica
Florence Tubach
Maxime Dougados
Dominique Salmon
Publication date
01-08-2010
Publisher
BioMed Central
Published in
Arthritis Research & Therapy / Issue 4/2010
Electronic ISSN: 1478-6362
DOI
https://doi.org/10.1186/ar3087

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